Journal of Adolescent Health
Volume 40, Issue 5 , Pages 456-461 , May 2007

The “Six T’s”: Barriers to Screening Teens for Substance Abuse in Primary Care

  • Shari Van Hook, M.P.H.

      Affiliations

    • Medicine, Children’s Hospital Boston, Boston, Massachusetts
    • Pediatrics, Harvard Medical School, Boston, Massachusetts
    • Corresponding Author InformationAddress correspondence to: Ms. Shari Van Hook, Center for Adolescent Substance Abuse Research, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115.
    • ,
  • Sion Kim Harris, Ph.D.

      Affiliations

    • Medicine, Children’s Hospital Boston, Boston, Massachusetts
    • Pediatrics, Harvard Medical School, Boston, Massachusetts
    • ,
  • Traci Brooks, M.D.

      Affiliations

    • Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts
    • ,
  • Peggy Carey, M.D.

      Affiliations

    • Family Medicine, University of Vermont College of Medicine, Burlington, Vermont
    • ,
  • Robert Kossack, M.D.

      Affiliations

    • Pediatrics, Fallon Clinic, Worcester, Massachusetts
    • ,
  • John Kulig, M.D., M.P.H.

      Affiliations

    • Pediatrics, Tufts New England Medical Center, Boston, Massachusetts
    • ,
  • John R. Knight, M.D.

      Affiliations

    • Medicine, Children’s Hospital Boston, Boston, Massachusetts
    • Pediatrics, Harvard Medical School, Boston, Massachusetts
    • ,
  • New England Partnership for Substance Abuse Research (NEPSAR)

Received 18 September 2006 ,Accepted 1 December 2006.

References 

  1. Horgan C, Skwara K, Strickler G. Substance Abuse: The Nation’s Number One Health Problem. Princeton, NJ: The Robert Wood Johnson Foundation; 2001;
  2. Hoyert D, Heron M, Murphy S, Kung HC. Deaths: final data for 2003. Natl Vital Stat Rep. 2006;54(13):1–120
  3. Pickrell T. Driver alcohol involvement in fatal crashes by age group and vehicle type: National Highway Traffic Safety Administration’s National Center for Statistics and Analysis, 2006. NHTSA Research Note DOT HS 810 598.
  4. Johnston LD, O’Malley PM, Bachman JG, et al. Monitoring the Future National Survey Results on Drug Use, 1975–2004. Volume I: Secondary Schools Students (NIH Publication No. 04-5727). Bethesda, MD: National Institute on Drug Abuse, 2005. Available from: http://www.monitoringthefuture.org/pubs.html
  5. Johnston L, O’Malley P, Bachman J, et al. (NIH Publication No. 06-5882) Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2005. Bethesda, MD: National Institute on Drug Abuse; 2006;
  6. Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance—United States, 2005. MMWR Surveill Summ. 2006;55:1–108
  7. Newacheck P, Brindis CD, Cart C, et al. Adolescent health insurance coverage: recent changes and access to care. Pediatrics. 1999;104:195–202
  8. Aarons GA, Brown SA, Coe MT, et al. Adolescent alcohol and drug abuse and health. J Adolesc Health. 1999;24:412–421
  9. Substance Abuse and Mental Health Services Administration. The Relationship between Mental Health and Substance Abuse Among Adolescents. Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services Administration; 1999;
  10. Kulig J American Academy of Pediatrics Committee on Substance Abuse. Tobacco, alcohol and other drugs: the role of the pediatrician in prevention, identification, and management of substance abuse. Pediatrics. 2005;115:816–821
  11. Knight J. The role of the primary care provider in preventing and treating alcohol problems in adolescents. Ambul Pediatr. 2001;1:150–161
  12. Gray K, Upadhyaya H, Deas D, et al. Advances in diagnosis of adolescent substance abuse. Adolesc Med Clin. 2006;17:411–425
  13. In:  Elster A,  Kuznets N editor. AMA Guidelines for Adolescent Preventive Services (GAPS). Baltimore, MD: Williams & Wilkins; 1994;
  14. In:  Jellinek M,  Patel BP,  Froehle MC editor. Bright Futures in Practice: Mental Health—Volume I. Practice Guide. Arlington, VA: National Center for Education in Maternal and Child Health; 2002;
  15. Goldenring J, Rosen D. Getting into adolescent heads: an essential update. Contemp Pediatr. 2001;21:64
  16. Knight J, Sherritt L, Shrier L, et al. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156:607–614
  17. American Academy of Pediatrics Committee on Substance Abuse. Testing for drugs of abuse in children and adolescents. Pediatrics. 1996;98:305–307
  18. Levy S, Harris S, Sherritt L, et al. Drug testing of adolescents in general medical clinics, in school and at home: physician attitudes and practices. J Adolesc Health. 2006;38:336–342
  19. American Academy of Pediatrics. Periodic Survey of Fellows #31: Practices and Attitudes Toward Adolescent Drug Screening. Elk Grove Village, IL: American Academy of Pediatrics, Division of Child Health Research; 1997;
  20. Millstein S, Marcell A. Screening and counseling for adolescent alcohol use among primary care physicians in the United States. Pediatrics. 2003;111:114–122
  21. Halpern-Felsher B, Ozer E, Millstein S, et al. Preventive services in a health maintenance organization: how well do pediatricians screen and educate adolescent patients?. Arch Pediatr Adolesc Med. 2000;154:173–179
  22. Danielsson P, Rivara F, Gentilello L, et al. Reasons why trauma surgeons fail to screen for alcohol problems. Arch Surg. 1999;134:565–568
  23. Barry K, Blow F, Willenbring M, et al. Use of alcohol screening and brief interventions in primary care settings: Implementation and barriers. Subst Abus. 2004;25:27–36
  24. Krueger R, Casey M. Focus Groups: A Practical Guide for Applied Research. Third edition. Thousand Oaks, CA: Sage Publications, Inc; 2000;
  25. Ford C, Millstein S, Halpern-Felsher B, et al. Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. JAMA. 1997;278:1029–1034
  26. Council on Scientific Affairs, American Medical Association. Confidential health services for adolescents. JAMA. 1993;269:1420–1424
  27. Sigman G, Silber T, English A, et al. Confidential health care for adolescents: position paper for the Society of Adolescent Medicine. J Adolesc Health. 1997;21:408–415
  28. Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131:1121–1123
  29. Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—II. Addiction. 1993;88:791–804
  30. Rahdert ER, ed. The Adolescent Assessment/Referral System Manual (DHHS Publication No. (ADM)91-1735). U.S. Department of Health and Human Services Alcohol, Drug Abuse, and Mental Health Administration, 1991.
  31. Trowbridge M, Sege R, Olson L, et al. Intentional injury management and prevention in pediatric practice: results from 1998 and 2003 American Academy of Pediatrics periodic surveys. Pediatrics. 2005;116:996–1000
  32. Sices L, Feudtner C, Mclaughlin J, et al. How do primary care physicians identify young childrens with developmental delays? (A national survey). J Dev Behav Pediatr. 2003;24:409–417
  33. Zuckerman B, Stevents G, Inkelas M, et al. Prevalence and correlates of high-quality basic pediatric preventive care. Pediatrics. 2004;114:1522–1529
  34. Waalen J, Goodwin M, Spitz A, et al. Screening for intimate partner violence by health care providers: barriers and interventions. Am J Prev Med. 2000;19:230–237
  35. Rahimian A, Driscoll M, Taylor D. The maternal and child health sites’ practices regarding HIV education, counseling, and testing of women of reproductive age in Chicago: barriers to universal implementation. Matern Child Health J. 1998;2:35–44
  36. Sugg N, Inui T. Primary care physicians’ response to domestic violence: opening Pandora’s box. JAMA. 1992;267:3157–3160
  37. Love C, Gerbert B, Caspers N, et al. Dentists’ attitudes and behaviors regarding domestic violence (The need for an effective response). J Am Dent Assoc. 2001;132:85–93
  38. Epstein R, Morse D, Frankel R, et al. Awkward moments in patient-physician communication about HIV risk. Ann Intern Med. 1998;128:435–442
  39. McCormick K, Cochran N, Back A, et al. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–972
  40. Bernard D, Quine S, Kang M, et al. Access to primary health care for Australian adolescents: how congruent are the perspectives of health service providers and young people, and does it matter?. Aust N Z J Public Health. 2004;28:487–492

PII: S1054-139X(06)00592-1

doi: 10.1016/j.jadohealth.2006.12.007

Journal of Adolescent Health
Volume 40, Issue 5 , Pages 456-461 , May 2007

Article Tools